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In the UK, adults with confirmed B12 deficiency and neurological symptoms typically receive hydroxocobalamin injections1 mg intramuscularly on alternate days until symptoms stabilise, followed by maintenance doses every two months
Additionally, alcohol can exacerbate gastrointestinal side effects such as nausea and may contribute to dehydration if combined with vomiting or diarrhea caused by the medication
Because preservative effectiveness is only required to be demonstrated for 28 days after first entry, standard multiple-dose vial practice, reflected in CDC injection safety guidance, is to date the vial at first puncture and discard it 28 days later
For multi-draw reconstitution where isotonicity is not needed, BAC water is the better option
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